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Health Protocols

Celiac Disease and Non-Celiac Gluten Sensitivity

Introduction

Celiac disease is an inflammatory immune disorder that occurs in genetically susceptible individuals. In people with celiac disease, ingestion of gluten—the protein fraction of wheat, barley, and rye—provokes an immune attack that inflames and damages the lining of the small intestine. This typically results in nutrient malabsorption along with a wide variety of symptoms, ranging from diarrhea and constipation to skin rashes and depression (Brown 2012; Korponay-Szabo 2012; Lerner 2014; A.D.A.M. 2014). The reaction to gluten triggered by celiac disease is not an allergy, but rather an insidious inflammatory immune condition (FARE 2015a).

Untreated celiac disease can lead to the development of a host of other conditions including osteoporosis, infertility, neurological disorders, other autoimmune diseases, and in some cases, cancer (Ventura 1999; Fasano, Catassi 2012; Rashtak 2012; Kagnoff 2007; Sapone 2012; Bai 2013; UCMC 2014).

The prevalence of celiac disease has been rising sharply in recent decades. The reasons for the increase are not fully understood, but are thought to be due in part to better detection and diagnosis rates, as well as an actual increase in incidence, which may be a result of increasing dietary gluten content or changes in infant feeding patterns, among other possibilities (Sapone 2012). At least three million Americans, or approximately 1% of the US population, have celiac disease, making it more than four times as common today than just 30 years ago (Lundin 2012; Rubio-Tapia 2009; Lohi 2007).

Celiac disease is largely a hidden epidemic, since it is estimated that an alarming 85–90% of individuals in the United States who have celiac disease remain undiagnosed (Ferri 2015). In the United States, it takes an average of four years for a symptomatic person with celiac disease to be diagnosed, a delay that markedly increases the risk of developing autoimmune disorders, neurological problems, osteoporosis, and cancer (UCMC 2014).

In addition, emerging evidence suggests the existence of a clinically distinct sensitivity reaction to gluten-containing grains. This more recently characterized disorder has been referred to as both non-celiac wheat sensitivity and non-celiac gluten sensitivity (Carroccio 2012; Marchioni Beery 2015). This condition was described in the 1980s, and evidence for the existence of non-celiac gluten sensitivity has grown in recent years. Estimates suggest non-celiac gluten sensitivity is six times as common as celiac disease (Jackson 2012; Catassi 2013; Lundin 2012; Czaja-Bulsa 2014; Sapone 2012). Some recent research indicates that it may not be gluten or other proteins that cause people without celiac disease to react to these foods, but rather difficult-to-digest carbohydrates called FODMAPs (Biesiekierski 2013).

People with non-celiac gluten sensitivity can experience a spectrum of symptoms similar to those caused by celiac disease, such as abdominal pain, diarrhea, joint pain, and depression. Non-celiac gluten sensitivity does not appear to be an autoimmune condition, making it distinct from celiac disease; neither is non-celiac gluten sensitivity an allergic condition, which distinguishes it from classical wheat allergy (Sapone 2012). In fact, there are currently no universally recognized laboratory tests or biomarkers for non-celiac gluten sensitivity; the condition can be diagnosed by a double-blind challenge with gluten-containing food (Jackson 2012; Catassi 2013; Lundin 2012).

Currently, the only recognized treatment for celiac disease is strict, lifelong adherence to a gluten-free diet. This means avoiding all foods containing wheat, rye, barley, and their derivatives, as well as gluten-containing non-foods such as medicines and supplements. People with celiac disease must also be careful when selecting foods such as oats that may be contaminated with gluten-containing grains (Bai 2013; Sapone 2012; Fasano, Catassi 2012).

However, the gluten-free diet is nutritionally inadequate in some cases, whether as a result of poor food choices or inherent deficiencies in the diet due to lack of nutritional fortification of gluten-free foods (Shepherd 2013). While the gluten-free diet is also used to treat non-celiac gluten sensitivity, the need for strict adherence or permanency is not clear (Sapone 2012).

This protocol will give you a better understanding of celiac disease and non-celiac gluten sensitivity, and how they differ. The gluten-free diet will be reviewed and new treatment frontiers will be discussed. You will also learn about lifestyle changes and targeted nutritional support with several natural compounds that can complement the gluten-free diet by correcting nutritional deficiencies, promoting intestinal healing, balancing the immune system, and reducing chronic inflammation.